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HCC: SYSTEMIC THERAPY FIRST LINE Akshjot Puri, MD Post Graduate - - PowerPoint PPT Presentation
HCC: SYSTEMIC THERAPY FIRST LINE Akshjot Puri, MD Post Graduate - - PowerPoint PPT Presentation
HCC: SYSTEMIC THERAPY FIRST LINE Akshjot Puri, MD Post Graduate Year 5 MENTOR: Madappa N. Kundranda, MD. PhD. CASE A 72 yo female with history of HCV cirrhosis (Child Pugh A) is found to have liver masses on screening ultrasound AFP 1072
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QUESTION 1
What would be a first line treatment choice for this patient? A.Y90 arterial embolization B.TACE
- C. Lenvatinib
- D. Liver directed therapy + Lenvatinib
- E. Sorafenib
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At 5 months from diagnosis Y90 to right and left hepatic arteries with favorable treatment response AFP 1072 27 27
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At 9 months from diagnosis AFP 1072 27 82 Star arted on Lenvat atinib-> unable to tolerate due to nausea, headaches and hot flashes Star arted on Sorafenib-> unable to tolerate due to chest pain few hours after medication, severe hand foot syndrome being unable to walk and extreme sensitivity to hot water, nose bleeds
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QUESTION 2
What is the next choice of systemic therapy for this patient?
- A. Cabozantinib
- B. Ramucirumab
- C. Regorafenib
- D. Nivolumab
- E. Pembrolizumab
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- Patient was started
- n Nivolumab
- After the 2nd
infusion patient developed a diffuse rash involving the face and upper trunk
CASE
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QUESTION 3
What is the next step in therapy for this patient?
- A. Discontinue Nivolumab
- B. Start oral steroids
- C. Switch to Regorafenib
- D. Initiate topical steroids and continue to hold
nivolumab
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CASE
- Patient was started topical steroids
- Nivolumab was reinitiated after resolution of the
rash
- Restaging scans after 3 months demonstrated a